The digital hospital: from the front desk to interoperability

A modern hospital does not have "an IT system". It has between five and fifteen of them, bought in different years from different vendors, each with its own database. The director sees one screen at the front desk, but behind it data is retyped by hand and lost at every handover. This article explains, without unnecessary jargon, what a hospital's digital infrastructure is made of, what the European Union will require in the coming years, and how useful automation can be added without replacing anything that works.

Which systems a hospital actually runs

Most hospitals in Romania and the Republic of Moldova have, in one form or another, the same building blocks:

• HIS / EHR (Hospital Information System / Electronic Health Record): the main system, holding the patient chart, admissions, discharges, diagnoses and procedures.
• LIS (Laboratory Information System): receives test orders, talks to the analysers and returns results.
• RIS / PACS (Radiology Information System / Picture Archiving and Communication System): schedules and reports imaging studies; PACS stores the images themselves.
• Scheduling and front desk: sometimes a HIS module, sometimes a separate application, sometimes a paper diary.
• Billing and claims: reporting services to the insurer and invoicing private patients.
• Telephony and call centre: the switchboard, call queues, sometimes a CRM (Customer Relationship Management) tool for patients.

In the Republic of Moldova, public institutions use national systems: SIA AMP (the Automated Information System "Primary Health Care") for family medicine and outpatient care, and SIA AMS (the Automated Information System "Hospital Care") for hospitals. The National Programme for Digitalisation and Innovation in Health 2025-2030 describes them plainly: they contribute to "partial digitalisation" but "do not ensure full interoperability", according to the Government of the Republic of Moldova.

Why they do not talk to each other

Each system was bought to solve a local problem. Nobody bought "data exchange". The result: the patient has three different numbers, the lab result is printed and scanned into the chart, and the monthly report is assembled in Excel.

The Moldovan programme names the causes without softening them: "outdated digital infrastructure, fragmentation of existing solutions, lack of interoperability and common standards", plus "the lack of reusable classifiers and nomenclatures", which "leads to repeated data entry in existing systems". In Romania, the Digital Decade 2025 country report notes that "less than 50% of the categories of healthcare providers are connected and supplying data" to the national electronic health record, according to the Council of the EU.

Lack of interoperability is not a technical problem but a procurement one: the systems were bought separately, with no shared requirement to exchange data.

Interoperability standards, explained simply

Interoperability means two systems can exchange data and understand it the same way. Four families of standards cover almost everything a hospital needs.

HL7 v2 is the oldest common language between medical systems. It is event-driven: when a patient is admitted, the HIS sends a message; when the laboratory validates a result, the LIS sends another. Messages are structured text divided into segments, easy for machines to process. It is the standard FHIR learned from, according to HL7, and it is still found in many HIS, LIS and PACS integrations.

HL7 FHIR (Fast Healthcare Interoperability Resources) is the current standard. HL7 International defines it as "a standard for exchanging healthcare information electronically", built from "resources" (patient, appointment, result, medication) that can be combined. Data travels as JSON or XML over ordinary web interfaces, and the current published version is R5. FHIR was designed from the lessons of HL7 v2, v3 and CDA, according to HL7. For a director, the practical point: FHIR is the language modern applications speak and the one new European rules call for.

DICOM (Digital Imaging and Communications in Medicine) is "the international standard for medical images and related information", recognised as ISO 12052 and first published in 1993, according to the DICOM Standards Committee. Every CT, MRI, ultrasound or X-ray device produces DICOM files; the PACS stores and displays them.

IHE profiles (Integrating the Healthcare Enterprise) are not new standards but recipes for using existing ones. IHE describes them as "a common language for purchasers and vendors" when discussing integration, which reduces "the complexity, cost and anxiety of implementing interoperable systems". When you write a tender, ask for IHE profiles, not "HL7 compatibility" in general.

The European direction: EHDS and its deadlines

Regulation (EU) 2025/327 on the European Health Data Space (EHDS) was published in the Official Journal on 5 March 2025 and entered into force on 26 March 2025, according to the European Commission. Application is phased:

Deadline	What happens, according to the European Commission
March 2027	The Commission adopts the implementing acts with detailed rules
March 2029	Exchange of the first priority data categories (patient summaries, ePrescriptions and eDispensations); secondary-use rules apply to most data from electronic health records
March 2031	Exchange of the second priority categories (medical images, laboratory results, hospital discharge reports); secondary use extends to the remaining categories, including genomic data
March 2035	Third countries and international organisations may apply to join HealthData@EU

For EHR systems, the regulation "establishes a comprehensive pre- and post-market compliance framework": manufacturers must certify compliance with "strict security and interoperability criteria", according to the European Commission. For a hospital this means two things: the HIS you buy or renew now must be able to export the patient summary and the discharge report in the European format by the deadlines above, and the vendor must tell you in writing how.

The Republic of Moldova, a candidate country, has aligned explicitly: the 2025-2030 national programme is built "in accordance with Regulation (EU) 2025/327", provides for an interoperable national EHR (DES, Dosarul Electronic de Sănătate), a national Health Data Access Body, and adoption of HL7 FHIR, SNOMED CT and ICD-11, according to the Government of the Republic of Moldova.

Where Romania and Moldova stand

The European Commission measures citizens' access to their electronic health records every year with a composite indicator of 12 sub-indicators. The EU-27 average reached 83% in 2024, up from 79% in 2023, and the Digital Decade target is 100% in 2030, according to the Commission's study.

Romania made the most visible jump in the region: its score rose from 58.6 in 2023 to 75.1 in 2024, a growth rate of 28.2% against the EU's 4.5%, yet it remains below the European average of 82.7, according to the Council of the EU country report. The same report explains why: not all data types are available, and fewer than half of the provider categories supply data.

The digital backbone of the Romanian public system is PIAS (the Health Insurance IT Platform), run by the national insurer CNAS, with the components SIUI (reporting and claims), CEAS (the electronic insurance card) and DES (the electronic health record), according to CNAS. On 1 September 2026, CNAS launched the platform modernised under the national recovery plan together with the e-SănătateaMea patient portal, with a budget of RON 493 million excluding VAT, according to Economedia. The scale explains why integration with PIAS is the first test for any hospital system in Romania:

From the fourth quarter of 2026, online booking becomes mandatory for providers, according to the same source. Hospitals whose systems cannot expose an appointment diary through an interface will type the same data twice.

In the Republic of Moldova, the 2025-2030 programme has an estimated cost of MDL 831.9 million, of which MDL 259.8 million is for developing and implementing the national EHR, according to the Government. Measurable targets: more than 20 systems and registers integrated into the MConnect interoperability platform (from zero), at least 70% of the required systems modernised and integrated into MConnect and the EHR by 2030, and EHDS-compliant standardised data structures defined between Q2 2026 and Q4 2028.

Adding automation without replacing core systems

The good news for a director: you do not need to change the HIS to get SMS reminders, automatic reports or a telephone assistant. Three technical mechanisms make it possible to build "on top of" existing systems.

API (Application Programming Interface): an official door through which one application asks another for data. When the HIS has a FHIR API, the reminder application asks "which appointments are tomorrow?" and receives the list without touching the database.

Webhook: the reverse notification. Instead of the application asking every minute, the source system announces on its own: "a laboratory result has been validated". That is how an SMS to the patient can go out within seconds.

Message queue: a mailbox between systems. If PIAS or a national system is unavailable, messages wait in the queue and are delivered when the connection returns, in order, with nothing lost. The Moldovan programme describes exactly this problem: existing systems are "sometimes slow or unavailable".

These mechanisms support the automations with immediate effect:

• Appointment reminders and confirmations (SMS, call, WhatsApp), read from the HIS diary through the API and written back when the patient confirms or cancels.
• Daily reports on occupancy, waiting times or outstanding results, generated from the same sources rather than from spreadsheets sent by e-mail.
• Payments: a payment link sent automatically after a private consultation, reconciled in the billing system.
• Call routing: a voice assistant that takes the booking request, checks availability through the API and leaves only the complex cases to operators.

The golden rule: the core system remains the source of truth; the automation reads and writes through documented interfaces and logs every operation. None of these applications makes a diagnosis or replaces staff; they move repetitive work from people to machines.

Security basics, before any integration

Every new interface is also a new door. ENISA, the EU cybersecurity agency, analysed 215 publicly reported incidents in the health sector between January 2021 and March 2023. Hospitals were the target in 42% of incidents, patient data was the most targeted asset (30%), and the median cost of a major security incident in health is EUR 300,000, according to ENISA.

The same report shows that only 27% of surveyed health organisations have a dedicated ransomware defence programme and 46% have never performed a risk analysis. The measures ENISA recommends are basic: offline encrypted backups of critical data, stronger authentication, vulnerability handling and patching, incident response and continuity plans. From integration practice we add three simple rules: a segmented network (medical devices, HIS servers and workstations in separate zones), access logs kept for every read of patient data, and a separate technical account for each integration with minimum rights.

The legal framework has changed too. The NIS2 Directive (Directive (EU) 2022/2555) had to be transposed by Member States by 17 October 2024, lists healthcare among the 18 critical sectors and introduces "accountability of the top management for non-compliance with cybersecurity risk management measures", according to the European Commission. For a hospital director, security is no longer a topic delegated entirely to the IT department.

What this means for a hospital in Romania or Moldova

A realistic roadmap does not start with a large tender. It starts with an inventory.

1. System inventory. One page per system: what it does, who maintains it, which interfaces it has (API, HL7 v2, export), where the data lives, when the contract expires.
2. A unique patient identifier. Without a clear mapping between the patient numbers in the HIS, LIS and PACS, any automation will make mistakes. It is the first thing to fix, before any new screen.
3. A first small integration with a visible result. Appointment reminders or laboratory results sent automatically. Measure before and after: no-shows, calls to the front desk, hours of manual work.
4. Interoperability requirements in every new contract. By March 2029 you must be able to exchange patient summaries and prescriptions in the European format; by March 2031, images, laboratory results and discharge reports, according to the European Commission. For the Republic of Moldova, the national programme sets EHDS-compliant data structures for 2026-2028 and MConnect integration by 2030.
5. Security hygiene before expansion. Tested backups, segmentation, access logs, then the next integration.

Questions to ask any vendor before signing:

• Do you expose a FHIR API? For which resources (Patient, Appointment, Observation, DiagnosticReport)? With what documentation?
• Which IHE profiles do you support, and with which systems have you demonstrated data exchange?
• What does interface access cost for a third party chosen by the hospital? Is it included in the licence or charged separately?
• How do you export all data at the end of the contract, and in what format?
• How will the system support the European EHR exchange format by the EHDS deadlines, and who is responsible for compliance?

Consdinamic builds software and AI to order, with its deepest specialisation in healthcare: a voice assistant for appointments, an FAQ chatbot, QR wayfinding and clinic websites, products used daily in a private medical network in Romania with 29 locations. Our approach starts from the interfaces of the systems already in place, not from replacing them, and we deliver in Romanian, Russian and English.

Conclusion

A hospital's digital infrastructure is a collection of good systems, bought separately, that were never required to talk to each other. The European Union has turned interoperability from a recommendation into an obligation with deadlines: 2027, 2029, 2031. Romania climbed from 58.6 to 75.1 in a year and is modernising PIAS; the Republic of Moldova has a programme with a budget and targets through 2030. For a director, the shortest path is the same in both countries: inventory, a unique identifier, a first measurable automation, clear requirements in contracts, and security hygiene before each next step.